Nipple Pain: Causes, Treatments, and Remedies
Albuquerque, New Mexico, USA
From: LEAVEN, Vol. 36 No. 1, February-March 2000, pp. 10-11
We provide articles from our publications from previous years for reference for our Leaders and members. Readers are cautioned to remember that research and medical information change over time
Throbbing, aching, cracked, bleeding, peeling, itching, burning, oozing, hurting, or simply sore are adjectives many new mothers use to describe their nipples when calling La Leche League for assistance. Studies have shown that 80 to 90 percent of breastfeeding women experience some nipple soreness, with 26 percent progressing to cracking and extreme nipple pain (Huml 1995). Sore nipples associated with breastfeeding are still a common problem. When nipples hurt, breastfeeding is in jeopardy and when breastfeeding is in jeopardy, the expertise of Leaders can do much to help.>
Causes of Nipple Pain
The most frequent causes of sore nipples are incorrect positioning at the breast and suction trauma. During the first two to four days after birth, the mother's nipples may feel tender at the beginning of a feeding as the baby's early suckling stretches her nipple and areolar tissue far back into his mouth. If a baby is positioned well at the breast, this temporary tenderness usually diminishes once the milk lets down, and disappears completely within a day or two (Mohrbacher and Stock 1997).
When helping a mother to overcome nipple pain caused by improper positioning, Leaders need to ask the mother about both the position of the nipple in the baby's mouth and the position of the baby's body in relation to his mother's body. A poorly latched baby may pinch off the nipple to protect his airway from a forceful milk-ejection reflex. Sometimes a baby will pinch the nipple or irritate it due to a short frenulum, short tongue, small mouth, receding chin, a high palate, or other anatomical condition (Wilson-Clay and Hoover 1999). THE WOMANLY ART OF BREASTFEEDING, BREASTFEEDING ANSWER BOOK, and several other reference books and pamphlets available through La Leche League International's catalog offer detailed information about proper positioning and evaluating latch-on for those who need more information.
Nipple soreness that increases or lasts beyond the first week should be interpreted as a warning that something is wrong. Once adjustments in positioning and latch-on have been made, a few days with little or no improvement suggest that the source of the pain lies elsewhere. Sucking problems, a retracted or improperly positioned tongue, strong clenching response, nipple confusion, and improper breast pump use are possible causes of nipple soreness.
Engorgement has been known to cause nipple pain (L'Esperance 1980). Engorgement of the breasts may predispose a mother to nipple tenderness, fissures and abscesses, and may lead to breastfeeding cessation (Hill and Humenick 1994). Hand-expressing a little milk ahead of time can soften the nipple and areola enough to avoid these problems.
Traumatized nipples can readily become infected with bacteria or yeast, delaying healing and causing pain even when positioning and latch-on are corrected (Brent et al. 1998). Another less common cause of nipple discomfort is a bleb, a smooth, shiny, white dot found at the nipple's tip, usually at the opening of a duct (Lawrence 1999). Sometimes a white, clear, or yellow milk blister appears on the nipple or areola causing soreness during a feeding. Warm compresses and frequent nursing are the keys to overcoming this obstacle.
If a mother has extreme pain when the nipples are exposed to the cold or when she is particularly stressed, she may be suffering from nipple vasospasm, also called Raynaud's of the nipple. The nipples will appear blanched after a feeding; sometimes they turn blue or red before returning to their normal color. A warm shower or heating pad can help to alleviate discomfort (Riordan and Auerbach 1999). The mother could also consider a suitable pain relieving or anti-inflammatory medication.
Skin conditions such as thrush, eczema, psoriasis, and poison ivy can be responsible for nipple soreness, as can allergic reactions to shampoos, deodorants, ointments, soaps, detergents, medications, or food particles in a baby's mouth. Some women are sensitive to the plastics in breast shells, nipple shields, and pump flanges. Sore nipples in later months may be related to sucking pattern changes in a teething baby. Even changes in saliva associated with teething can be responsible for nipple pain (Wilson-Clay and Hoover 1999). The hormonal changes of pregnancy can also cause sore nipples.
Treatments and Remedies
Surprisingly, clinical research has found that warm, moist compresses can be soothing for sore nipples (Buchko et al. 1993; Lavergne 1997). Bathing a crack with freshly expressed human milk may aid healing and offer antibacterial protection. Breast milk is readily available and has no adverse effects for either mother or baby, unless the mother has a yeast infection. Because yeast thrives in human milk, mothers with thrush should rinse their nipples with plain water to remove surface milk after feeding (Mohrbacher and Stock 1997). In all other cases, expressed breast milk, in conjunction with correct positioning and latch, is the remedy of choice in much of the world.
In some locations, wet tea bags remain a popular folk remedy for the treatment of nipple pain. They are inexpensive and can be found in most homes, making them easily accessible at the onset of difficulties. They may be soothing because of the moist warmth. Tea bags have been the subject of a number of studies; they appear neither to prevent nor reduce nipple soreness (Lavergne 1997). Furthermore, the tannic acid in the tea can act as an astringent causing drying and cracking, rather than healing.
Once the recommendations for treating sore nipples included drying the skin with a hair dryer or sun lamp. Then researchers discovered that healing is facilitated when the moisture already present in the nipple and areolar tissue is preserved. A moisture barrier applied to the injured area slows the evaporation of moisture naturally present in the skin. The resulting moist environment typically causes wounds to heal in 50 percent less time, without scab or crust formation (Huml 1995).
Most commercial preparations sold for the treatment of sore nipples are not useful; some may even cause harm. Home remedies like cooking oils or honey are also inappropriate. If a mother wishes to apply something to her nipples other than water or her own milk, Leaders should suggest only substances that are safe for human consumption and free of allergens; Lansinoh for Breastfeeding Mothers is such a product. This 100 percent anhydrous modified lanolin was developed specifically to create a moist healing environment for injured nipples (Huml 1995). It has been endorsed by La Leche League International in the USA, and is considered to be the purest and safest brand of modified lanolin available (La Leche League International 1997).
Recently some hospitals began providing mothers with hydrogel dressings to treat nipple soreness. However, one study was discontinued due to a high infection rate. The dressings are available in a variety of shapes and sizes and are comprised primarily of water without any added medication. Proponents claim that hydrogel dressings create a moist environment for healing, provide immediate pain relief upon application, absorb some drainage, act as a barrier, are non-adherent, and are cost-effective because they are designed to be reused. Hydrogel dressings should not be used in treating a wound if a bacterial or fungal infection is suspected, however. (Cable, Stewart and Davis 1997; Brent 1998). These dressings were designed for treatment of other types of wounds and there are unanswered questions concerning their use for sore nipples.
How can Leaders help?
When a mother calls for help with nipple pain or damage, it is important to listen carefully and ask precise questions that yield clear, definitive answers. A Leader may decide a home visit at either the mother's or the Leader's home will help her see possible causes of the mother's soreness. Assuring the mother that sore nipples do heal can bolster her confidence. If a mother's situation is determined to be outside the scope of the Leader's ability to help, a suitable referral to a more experienced Leader, a Board-certified lactation consultant, or other health care professional may be appropriate. The Leader can also suggest the mother consult her doctor about her nipple pain. Infected nipples may require a physician's prescription for antibiotics or antifungal agents. Dermatologists can be helpful in treating skin disorders of the nipple and areola.
A mother trying to overcome nipple pain may be confused by the myriad of commercial choices and folk remedies available to her. Accurate information will help the mother choose the most appropriate treatment for her and her baby. One remedy is not suitable for all situations and some substances are not appropriate under any circumstances. Many mothers benefit most from an experienced eye, an attentive ear, and a gentle touch, skills in which La Leche League Leaders excel.
Brent N., et al. Sore nipples in breastfeeding women. Archives Pediatric Adolescent Medicine Nov 1998; 152: 1077-82.
Buchko, B. L., et al. Comfort measure in breastfeeding primiparous women. Journal of Obstetrics Gynecology Neonatal Nursing Jan 1994; 23: 46-52.
Cable, B., et al. Nipple wound care: a new approach to an old problem. Journal of Human Lactation Dec 1997; 13(4): 313-18.
Hill, P.D. and Humenick, S.S. The occurrence of breast engorgement. Journal of Human Lactation June 1994; 10(2): 79-86.
Huml, S. Cracked nipples in the breastfeeding mother. Advance for Nurse Practitioners April 1995.
Lavergne, N.A. Does application of tea bags to sore nipples while breastfeeding provide effective relief? Journal of Obstetrics Gynecology and Neonatal Nursing Jan-Feb 1997; 26: 53-58.
Lawrence, R.A. and Lawrence, R.M. Breastfeeding: A Guide for the Medical Profession. St. Louis, MO: Mosby, Inc., 1999; 259-63.
L'Esperance, C. Pain or pleasure: the dilemma of early breastfeeding. Birth 1980; 7: 21-26.
Mohrbacher, N. and Stock, J. BREASTFEEDING ANSWER BOOK. Revised Edition. Schaumburg, Illinois: LLLI, 1997; 45-76, 387-411.
Riordan, J., Auerbach, K. Breastfeeding and Human Lactation. Boston, MA: Jones and Bartlett, 1999; 315-23, 492-93.
THE WOMANLY ART OF BREASTFEEDING. Schaumburg, Illinois: LLLI, 1997; 113-21.
THE WOMANLY ART OF BREASTFEEDING, NEW 8th Edition, published by La Leche League International, is the most complete resource available for the breastfeeding mother.LLLI Breastfeeding Tips and Products includes helpful answers to frequently asked breastfeeding questions plus a section that features books and products.
Wilson-Clay, B. and Hoover, K. The Breastfeeding Atlas. Austin, TX: LactNews Press; 1999.